男性不育
治疗

任何生育治疗都可能在大约开始三个月后对精液质量产生影响, as this is the length of time required for a single cycle of spermatogenesis, 或精子生产. 如果手术或药物治疗都不合适, 辅助生殖技术是可能的.

在选择治疗方案时, 应该考虑双方的长期目标, 金融约束, 和 the results of the female partner's evaluation in addition to male factor findings.

具体的治疗

The most successful medical therapy for male infertility involves reversing chemical, 感染或内分泌失衡. 这就是所谓的特殊疗法, 和 it is usually successful because treatment is based on the correction of well-defined problems.

这方面的例子包括:

治疗急性前列腺炎、附睾炎或精索静脉曲张
替代垂体激素——促卵泡激素(FSH)和白细胞生成素(LH)，以治疗放疗或手术引起的垂体疾病
The administration of testosterone in men with hypo和rogenic hypogonadism

经验治疗

Another kind of treatment, called empiric therapy, attempts to correct rather ill-defined conditions. 使用柠檬酸克罗米芬, tamoxifen or ProXeed for low sperm density or motility are examples of this form of therapy.

这些治疗方法的成功往往有限，因为体内基本完整的机制往往会抵消预期的效果. 换句话说, hormonal treatments based on the principle that "if some hormone is good, “多多益善”是注定要失败的，应该避免.

辅助生殖技术

Treating specific illnesses may or may not treat the fertility problem. 至少10%的不孕不育问题是由于未知的原因，另外30%是由于男性和女性伴侣的问题.

In addition to medication 和 surgical infertility treatments to treat specific health conditions in men 和 women, a new class of treatments — called assisted reproductive technologies, 即ART -已经被开发出来. 最常见的抗逆转录病毒疗法是体外受精, 或试管婴儿, but new procedures can enhance the IVF process or address other infertility conditions. 这些男性手术包括:

胞浆内精子注射(ICSI)
血管的愿望
附睾的愿望
睾丸精子抽取
“映射”失败的睾丸
卵子捐赠者和胚胎或精液冷冻

胞浆内精子注射(ICSI)

胞浆内精子注射, 或ICSI, 是否开发了一种技术来帮助患有严重男性因素不孕不育的夫妇或在之前的体外受精尝试中失败的夫妇实现受精. 这一程序克服了受精的许多障碍，让那些成功受孕希望渺茫的夫妇获得受精胚胎.

1994年，UCSF医疗中心首次使用了该手术，1995年2月，在ICSI的帮助下，首例成功分娩. UCSF医疗中心是旧金山湾区第一个通过这种“奇迹”手术实现怀孕和分娩的项目.

这项技术需要非常精确的操作来获取单个活精子并将其直接注入人类卵子的中心. 该手术要求女性伴侣接受生育药物的卵巢刺激，以便发育几个成熟的卵子. 然后这些卵子被吸入阴道, 使用阴道超声, 和 incubated under precise conditions in the embryology laboratory. The semen sample is prepared by spinning the sperm cells through a special medium. This solution separates live sperm from debris 和 most of the dead sperm. The specialist picks up the single live sperm in a glass needle 和 injects it directly into the egg.

通过ICSI程序, many couples with difficult male factor infertility problems have achieved pregnancy. Fertilization rates of 70 percent to 80 percent of all eggs injected are currently being achieved, 和 pregnancy rates are comparable to those seen with IVF in couples with no male factor infertility.

请阅读常见问题:胞浆内精子注射有关此程序的更多信息.

精子提取程序

胞浆内精子注射 has revolutionized the treatment of male infertility. 卵子受精所需的精子数量已经从体外受精(IVF)所需的数十万减少了。, 与体外受精相结合时需要一个可存活的精子.

这导致了近年来积极的新手术技术的发展，为精子数低或没有精子数的男性提供可存活的精子，用于卵子受精. This also has pushed urologists beyond the ejaculate 和 into the male reproductive tract to find sperm. 目前, 无精子症患者的精子来源, 或者那些没有射精的人, 包括输精管, 附睾和睾丸, using sperm aspiration techniques in which the sperm is suctioned from the organ.

精子抽吸技术包括使用小型外科手术从生殖器内的器官收集精子. 这些技术适用于无法输送精子的男性，因为正常情况下输送精子到射精的导管系统缺失, 比如先天性输精管缺失, 或无法重建.

最近, 在60%到70%的情况下，精子已经被相当可靠地从男性的睾丸中提取出来，这些男性的精子产生问题非常严重，以至于在射精管中找不到精子.

认识到这一点很重要, 然而, that IVF technology is required to achieve a pregnancy with the vast majority of these extraction procedures, 而且成功率与夫妻双方复杂的互补的辅助生殖计划密切相关.

精子提取:血管吸吸

在前列腺水平或输精管的腹部或盆腔部分有先天性或后天导管系统梗阻的患者可以采用这项技术. 病人 who have undergone a vasectomy less than five years before also may be c和idates.

血管的愿望 is a brief, same-day operation 在局部麻醉的情况下. It can be done through a small scrotal incision or through incisionless techniques. 无论哪种方式, the vas deferens is entered 和 a syringe is used to suction leaking sperm into a nourishing fluid. More sperm are brought to the opening by gently massaging the epididymis 和 vas deferens. 恢复时间为24小时. Aspirated sperm are specially processed 和 prepared for insemination 或试管婴儿.

三种提取方法中的一种, 输精管吸吸提供最“成熟”的精子, 因为它们已经穿过附睾了, 在正常精子发育过程中发生的成熟过程. 通常情况下，ICSI是不需要怀孕的. 输精管精子的一大好处是，它基本上等同于射精，因此可以在手术时将其冷冻起来，以避免在男性体内进行进一步的手术.

精子提取:附睾抽吸

在输精管缺失或术前手术留下疤痕的情况下可以进行附睾吸精, 外伤或感染. 精子是直接从一个人身上采集的, 孤立附睾小管(MESA)或盲针穿刺(PESA)与输精管手术的方式大致相同. Depending on the length of the epididymis that is available for aspiration, 多个, separate aspiration attempts can be made from one or both testicles.

当获得1000万到2000万个精子时, 精子经过加工后与伴侣的卵子受精. 附睾精子不像那些穿过整个附睾并驻留在输精管和输精管中的精子那样“成熟”, 作为一个后果, 附睾精子需要ICSI才能使卵子受精.

据报道，附睾精子的受精率为60% ~ 80%，受精率约为45% ~ 55%. 很明显, 由于精子和卵子质量的差异以及实验室的技术熟练程度，结果会因个体而异. 像血管的精子, these sperm can be frozen at the time of surgery to eliminate future surgical sperm retrieval procedures.

Sperm Extraction: Testicular Sperm Extraction (TESE); Testicular Sperm Aspiration (TESA)

The newest of the aspiration techniques is testicular sperm retrieval. 在这个过程中，少量的睾丸组织被取走活组织检查在局部麻醉的情况下. 这是一个突破，因为它证明了精子不需要“成熟”并通过附睾才能使卵子受精. 然而，由于睾丸精子不成熟，需要ICSI.

睾丸取精术适用于睾丸附近的附睾阻塞，这种阻塞可能是之前手术造成的, 感染或出生, 或者是睾丸导管堵塞, 叫传出微胆管.

它也被用于精子产量极低的男性, in which so few sperm are produced that they cannot reach the ejaculate. 现在，由于精子产量不佳而怀孕是家常便饭, 但使用这种精子还是有一些问题，因为在大多数情况下，导致精子产生不良的潜在利来登录网址仍然是未知的. 因此, 在这些情况下, it must be realized that the condition which may have caused the infertility may be transmitted to the progeny.

最近, 甚至精子细胞——最终变成有尾巴的圆形细胞——也被用来通过ICSI受孕. 然而, 在对该系统进行适当的研究并在动物模型中检验其遗传稳定性之前，这就引起了人们对使用仍在进化的生殖细胞的遗传物质用于临床目的的许多猜测和担忧. Spermatid injections are currently considered experimental procedures.

One drawback of testis sperm is that is does not freeze as readily as epididymal or vasal sperm, so it is more likely that the male partner will need to undergo repeated procedures for each IVF attempt.

精子提取:“测绘”失败的睾丸

1997年首次提出, this concept addressed the issue of how to detect where ICSI-compatible, 成熟精子存在于衰竭或萎缩的睾丸中. It was based on prior observations that sperm production can be "patchy" or "focal" within the failing testis. This led to the idea that the more sites that are sampled within the testis to look for sperm, 精子可用的几率就越高.

从“映射”得到的信息可以使用如下: